Management of Asthma: Beyond the Cost

Introductions

Introduction

Allen Kaplan

March 9, 2003

Welcome to the WAF Symposium: "Management of Asthma - Beyond
the Cost." The World Allergy Organization (WAO) is pleased
to be able to present this Symposium because of the prominence
of asthma as a worldwide disease, and the apparent increase in
incidence, morbidity, and mortality observed in many countries
during the past 10-20 years.

This dynamic may seem paradoxical because we clearly have had
new, more effective medications available for the treatment of
asthma. The reasons for this prominence are clearly multifactorial,
and one about which we can do little in the short run, would be
genetic drift leading to a true increase in allergic responsiveness
with the lung as a major target organ. However we should be able
to intercede and affect the incidence and cause of the disease
in our patients by consideration of impediments to optimal care,
including prevention and treatment.

Today you will hear lectures from internationally recognized
experts from England, France, and the USA who will address many
facets of this dilemma, including a discussion of the impact of
asthma on society, its contribution to the general problem of
rising medical costs, and most importantly, identification of
areas that can be addressed to try to reverse the trend.

Among the issues to be discussed are the education of the patient
regarding their own management of symptoms, improving compliance
with recommendations where cost may be a factor, environmental
measures to lower the allergen load as well as exposure to irritants
and pollutants, and approaches to improve access to medical care.
There is a particular problem in inner city environments where
exposure to house dust, cockroach, and cigarette smoke may represent
particular challenges. Finally improved use of the many excellent
medications currently available and increased research to develop
new modalities of treatment, particularly for severe persistent
asthma, are important considerations to optimize current therapy
and to lead to new approaches for the future.

Introduction

Asthma is a common chronic disease that places many burdens on
the individual sufferer, his or her family, healthcare systems
and society as a whole.

While there have been advances in the management of asthma over
recent years, the burden of asthma in terms of morbidity and mortality,
world-wide, remains enormous.

During the 1980s, asthma mortality in many countries increased.
In many instances, a significant number of asthma deaths could
be considered "avoidable". Asthma mortality rates are
greater among disadvantaged populations where there are crowded
living conditions, poor educational levels, and poverty .The reasons
for the differences in mortality rates in different populations
are complex but probably include differences in risk factors for
the disease, and barriers to good asthma medication and management.

The economic impact of asthma is large and growing in both the
developed and developing world. Factors contributing to the socio-economic
costs include direct costs such as hospital care, physician services,
laboratory and diagnostic service costs and medications. Many
other indirect costs must also be considered, including lost days
from work and school, caregiver time, allergen avoidance strategies
and environmental modifications, as well as the community loss
from early mortality.

Reducing the global burden of asthma when resources are scarce
will involve a number of important initiatives:

Asthma must be seen to be an important health issue and its
impact on the individual and the community as a whole must
be appreciated;

Promotion of education about asthma to identify and avoid
risk and triggering factors;

Provision of enough well trained health care professionals
to service the needs of those with the disease in a given
community;

Implementation of international management guidelines , providing
the means for this to be done effectively, with sensitivity
to local conditions;

Provision of, and improvement in, the use of cost effective
medication;

Provision of regular follow up health care to minimise severe
exacerbations and hospitalisations.

The World Allergy Organisation is proud to be sponsoring this
WAF Symposium where a panel of internationally acclaimed speakers
will explore the many complex issues regarding the global burden
of asthma management.